High incidence of sudden death with conduction system and myocardial disease due to lamins A and C gene mutation

We studied 54 living relatives from a large French kindred, among which 17 members presented with a cardiomyopathy transmitted on an autosomal dominant mode. Five of these individuals had clinical manifestations of muscle disease phenotypically consistent with Emery-Dreifuss muscular dystrophy. Genetic analysis of this kindred had demonstrated a nonsense mutation in the LMNA gene located on chromosome 1q11-q23. This gene encodes lamins A and C, proteins of the nuclear lamina located on the inner face of the nuclear envelope. We retrospectively determined the cause of death of 15 deceased family members, 8 of whom had died suddenly, 2 as a first and single manifestation of the disease. The six other cases had histories of arrhythmias and left ventricular dysfunction before dying suddenly, and three of them died despite the prior implantation of a permanent pacemaker. The mean age of onset of cardiac symptoms among affected living family members was 33 years (range 15-47 years), and the first symptoms were due to marked atrioventricular conduction defects or sinus dysfunction, requiring the implantation of permanent pacemakers in seven cases. Myocardial dysfunction accompanied by ventricular arrhythmias developed rapidly in the course of the disease and resulted in severe dilated cardiomyopathy requiring cardiac transplantation in three cases. In conclusion, in patients presenting a life-threatening familial or sporadic cardiac restricted phenotype similar to that described here, mutations in the lamins A and C gene should be looked for. In the genotypically affected individuals, cardiological and electrophysiological follow-up should be performed to prevent sudden death that could occur rapidly in the evolution of such disease.

Immunologic and genetic characterization of S180, a cell line of murine origin capable of growing in different inbred strains of mice

Some of the immunologic and genetic properties of the cell line S180 have been examined. These cells grew without restrictions in the peritoneal cavity of different inbred strains of mice and invariably killed the animals. With Northern blots it was demonstrated that S180 cells contained class I mRNAs but failed to transcribe B2m genes. However, under experimental conditions, a protective humoral immune response mediated by cytotoxic antibodies and complement against S180 cells was obtained through non-H-2 antigens in C57BL/6J mice.

A case of mitral-aortic intervalvular fibrosa aneurysm with unique flow patterns and long-term natural survival

We report a patient with a large aneurysm of mitral-aortic intervalvular fibrosa as a complication of prosthetic aortic valve endocarditis diagnosed on transthoracic echocardiography. This aneurysm began to expand with atrial systole, filled fully during ventricular systole, and collapsed in diastole on transesophageal examination. The patient refused corrective surgery and has survived on medical treatment for close to 2 years.

Non-Hodgkin's lymphomas in Mexico. A clinicopathological and molecular analysis

It is now well established that the clinical and histopathological characteristics of non-Hodgkin's lymphomas may vary significantly throughout the world. However, only a few reports have been published in Latin American countries. In this work, the clinical and pathologic findings of 264 patients with non-Hodgkin's lymphomas in Mexico City were analyzed. Diffuse large (14%) and diffuse mixed cell types (20%) predominated among nodal lymphomas. Within the group of patients with high grade malignancies, immunoblastic sarcomas were the most common (40/48). It is important to mention that follicular lymphomas were sporadic (4.5%). Among extranodal lymphomas the most commonly involved site was the gastrointestinal tract (11.3%), followed by the midline (6%). Molecular analysis of 65 cases with immunoglobulin and T-cell receptor gene probes showed that most lymphomas were of B-cell lineage (66%). The remaining group was composed of T-cell (25%) and bigenotypic malignancies (9%). All attempts to establish a correlation between the clinical stage and histopathological types with the genetic findings were not successful. However, pre-B and bigenotypic lymphomas were observed mainly in patients over 60 years of age. This study highlights some relevant characteristics of non-Hodgkin's lymphomas in Mexico.

Novel combination of c-myc, N-myc and N-ras oncogene alteration in brain tumors

We have examined forty human brain tumors (neoplasias presenting an important incidence in Mexico), for cellular myc (c-myc), N-myc and N-ras proto-oncogene alterations. An elevated amplification and/or rearrangement of the oncogenes was detected in most samples (60% presenting alteration for c-myc, 54% for N-myc, 6% for N-ras and 60% for ras-related genes). The tumors were of different histological types and for some of them we detected either amplification and/or rearrangement of the oncogenes. We describe, for the first time, the alterations of two related genes (c-myc and N-myc) in the same tumor samples; in 64% of the analyzed samples, oncogene alterations were accompanied by enhanced expression of N-myc and ras-related genes. These results suggest an important role for c-myc, N-myc and N-ras oncogenes, in the development and progression of brain tumors.

Population Genomics Provide Insights into the Global Genetic Structure of Colletotrichum graminicola, the Causal Agent of Maize Anthracnose

Understanding the genetic diversity and mechanisms underlying genetic variation in pathogen populations is crucial to the development of effective control strategies. We investigated the genetic diversity and reproductive biology of Colletotrichum graminicola isolates which infect maize by sequencing the genomes of 108 isolates collected from 14 countries using restriction site-associated DNA sequencing (RAD-seq) and whole-genome sequencing (WGS). Clustering analyses based on single-nucleotide polymorphisms revealed three genetic groups delimited by continental origin, compatible with short-dispersal of the pathogen and geographic subdivision. Intra- and intercontinental migration was observed between Europe and South America, likely associated with the movement of contaminated germplasm. Low clonality, evidence of genetic recombination, and high phenotypic diversity were detected. We show evidence that, although it is rare (possibly due to losses of sexual reproduction- and meiosis-associated genes) C. graminicola can undergo sexual recombination. Our results support the hypotheses that intra- and intercontinental pathogen migration and genetic recombination have great impacts on the C. graminicola population structure. IMPORTANCE Plant pathogens cause significant reductions in yield and crop quality and cause enormous economic losses worldwide. Reducing these losses provides an obvious strategy to increase food production without further degrading natural ecosystems; however, this requires knowledge of the biology and evolution of the pathogens in agroecosystems. We employed a population genomics approach to investigate the genetic diversity and reproductive biology of the maize anthracnose pathogen (Colletotrichum graminicola) in 14 countries. We found that the populations are correlated with their geographical origin and that migration between countries is ongoing, possibly caused by the movement of infected plant material. This result has direct implications for disease management because migration can cause the movement of more virulent and/or fungicide-resistant genotypes. We conclude that genetic recombination is frequent (in contrast to the traditional view of C. graminicola being mainly asexual), which strongly impacts control measures and breeding programs aimed at controlling this disease.

Damage in B2m genes and DNA methylation of H-2 genes are involved in loss of expression of class I MHC products on the membrane of LR.4, a cell line derivative of the T-cell lymphoma L5178Y

We have isolated an H-2 deficient cell line (LR.4) from the T-cell lymphoma L5178Y which grew without restrictions in the peritoneal cavity of different inbred strains of mice. The use of polyclonal anti-H-2 antiserum and complement indicated that LR.4 cells did not express class I determinants on the cell membrane. Southern blots of genomic DNA of LR.4 cells showed that B2m genes were severely damaged and that class I H-2 genes were extensively methylated. Consequently, LR.4 cells failed to transcribe mRNAs for both B2m and class I H-2 genes. On the other hand, specific immunity to LR.4 was demonstrated in C57BL/6J mice since, in subsequent challenges with either LR.4 or EL4.4, LR.4 did not grow, whereas EL4.4 grew and killed the mice. In C57BL/6J mice, rejection of LR.4 was accompanied by the production of cytotoxic antibodies. The immune response induced in C57BL/6J mice was determined by non-H-2 antigenic determinants in LR.4 cells.

[Psychiatrists' decision making and monitoring of antipsychotic prescription for elderly schizophrenia patients]

OBJECTIVE

Advancing age entails specific treatment modalities for patients with schizophrenia. The choice of appropriate antipsychotic therapy (AP) and the monitoring of treatment is a major challenge. However, little is known about the real-world prescribing practices of psychiatrists for elderly schizophrenia patients. The aim of this study was to assess prescribing practices and treatment monitoring in elderly schizophrenia patients and whether socio-professional psychiatrists' characteristics are related to their practices.

METHODS

We contacted by mail 190 psychiatrists to take part in an observational survey of their AP prescribing practices for elderly (aged over 65) schizophrenia patients.

RESULTS

The response rate was 44.2%, and of the psychiatrists who replied 75% were treating elderly schizophrenia patients. A second-generation AP (SGAP) was prescribed as first-line of treatment by 87.7% of the psychiatrists. The most frequently used SGAPs were risperidone and olanzapine (respectively preferred by 54.4% and 19.3% of the psychiatrists taking part). At the beginning of treatment, 91.1% of the psychiatrists prescribed a lower dose than for middle-aged patients. Of the psychiatrists taking part, 64.9% prescribed monotherapy; and among these psychiatrists, 65% cited insufficient control of the disease as the reason for their choice, while 48.7% of those who elected not to prescribe combined AP did so in order to limit the side-effects. Of the psychiatrists taking part, 54.4% prescribed long-acting injectable AP (LAAP); better therapeutic compliance and alliance was the main argument in the choice of LAAP given by the psychiatrists taking part who prescribed the drug, whereas the absence of indications and problems of tolerance were arguments against for those who did not. "Personal experience" emerged as the governing factor in the choice of AP. The AP side-effect profile was the main criterion of choice of the AP agent for 3.5% of the psychiatrists taking part, and the most frequently chosen secondary criterion (29.8%). Monitoring of treatment was partly performed according to professional recommendations: pre-treatment and post-prescription assessments of waist circumference and ophthalmological monitoring were very infrequent (8.8 to 18.5%) as were pre-treatment and early post-prescription assessments of prolactinaemia (14.8 to 20.4%); long-term cardiac monitoring was infrequent (43.9%). The psychiatrists taking part whose first-line drug was SGAP were more familiar with professional recommendations than those who prescribed first generation antipsychotic (FGA) drugs (72% as against 14.3%, P=0.006). Of the psychiatrists taking part in the study, 64.9% reported they commonly use professional recommendations. Psychiatrists who declared they commonly use professional recommendations measured pulse rate and blood pressure significantly more often over the long-term than those who did not (74.3% as against 41.2%, P=0.0315). They also measured waist circumference over the long-term significantly more often than psychiatrists who did not commonly use professional recommendations (22.9% as against 0%, P=0.0420). Psychiatrists treating more than ten of these patients yearly measured significantly more often over the long-term pulse rate and blood pressure than those treating fewer patients (80% as against 50%, P=0.0399). Over the long-term monitoring, psychiatrists with a larger number of elderly schizophrenia patients in their care also performed more often fasting blood glucose test, lipid profile and referral for cardiac consultation with ECG (respectively, 95.5% as against 70.8%, P=0.0489; 90.9% as against 58.3%, P=0.0182; 81.8% as against 29.2%, P<0.0001).

CONCLUSIONS

The results of this survey need to be confirmed in a larger population sample. The antipsychotic prescribing practices were broadly in agreement with current recommendations except for the tolerance profile which was not the first element taken into account in the choice of the AP agent. Some clinical and paraclinical medical examinations were carried out infrequently, in particular cardiac monitoring over the long-term, which is essential in this elderly patient population. One important element to emerge from our results was that common use of professional recommendations is associated with better monitoring.

A rare case of inferior venacaval type of atrial septal defect in an adult: echocardiographic features

We report a rare type of atrial septal defect with communication between the left atrium and the inferior vena cava. This type of defect has been referred to as a low sinus venous type of atrial septal defect because of its developmental origin, and possibly is caused by defective absorption of the left venous valve of the sinus venosus into the septum secundum. Detailed echocardiographic features are discussed.

Occurrence of human papillomavirus type 16 DNA sequences and c-myc oncogene alterations in uterine-cervix carcinoma

Using genetic engineering and molecular biology techniques, we have examined sixteen human carcinomas in the uterine-cervix tumors (the most frequent tumor in México, representing 34% of malignant tumors in women), for the presence of Human Papillomavirus type 16 (HPV-16) DNA sequences and possible alterations of the cellular myc (c-myc) proto-oncogene. In this study we have analyzed cervical carcinomas from patient with clinical stage II. We detected in 31% of these samples, the presence of HPV-16 sequences (2-100 copies). In addition, an elevated amplification (up to 80-fold in one tumor) and/or rearrangement of the c-myc oncogene was detected in most tumors (more than 90% of the samples). These results suggest that either c-myc oncogene and/or HPV-16 could play an important role in the development of uterine-cervix carcinoma.

Primary B cell lymphoma of the rectum in a patient coinfected with HIV-1 and HTLV-I

This report describes a clinical case of a large cell, immunoblastic plasmacytoid malignant B-cell lymphoma of the rectum in an AIDS patient coinfected with HTLV-I. The malignant cells showed clonal genetic rearrangement of the HC (JH) and LCK genes. Infection by EBV was demonstrated serologically and with slot blots using genomic DNA of the cancer cells. Southern blot analysis with DNA extracted from the lymphoma cells were negative for HTLV-I. The patient received seven cycles of VACO-B which induced complete but transient clinical remission of the tumor. The final outcome of the patient is unknown.

Specific recognition and rejection of the H-2-deficient cell line LR.4 by C57BL/6J mice

The humoral immune response developed by C57BL/6J mice against the beta 2-microglobulin (beta 2m) and major histocompatibility complex (MHC) class I- and class II-deficient cell variant of L5178Y, LR.4, is strain specific, is not linked to a given haplotype and involves at least one antigenic determinant expressed on the cell membrane. Anti-LR.4 antibodies can be detected in the serum and ascitic fluid of tumour-bearing animals, and in the serum of mice immunized with mitomycin C (MC)-treated cells. In vitro, cytotoxic T lymphocytes (CTL) cannot be induced under different experimental conditions. However, recognition and lysis of LR.4 are mediated by an antibody-dependent cell-mediated cytotoxicity (ADCC) mechanism in which natural killer (NK) cells extracted from the spleen of resistant or susceptible strains are the effector cells. The NK cells responsible for ADCC against LR.4 are not inducible with polyinosinic-polycytidylic acid (poly(I:C)) and could represent a subset that is not detectable by conventional assays. In conclusion, the incapacity of BALB/c and possibly of other strains of mice to reject LR.4 is determined by the failure to mount a humoral immune response.

Abstract P6-13-03: Symptomatic bone marrow involvement (BMinv) in breast cancer (BC): Clinical presentation, treatment and prognosis according to BC subtype and Zoledronic acid (ZA) use. A single institution review

Background: Symptomatic BMinv occurs in a minor proportion of metastatic BC patients (pts). Few data exist regarding its clinical presentation, prognosis and optimal treatment (Tx). ZA has shown to interrupt metastatic “vicious cycle” in bone and to “clear” micrometastastic BMinv in early BC, but its role in symptomatic BMinv remains unclear. We reviewed our series of pts with proven symptomatic BMinv, focusing on Tx delivered and prognosis according to BC subtype and ZA use.

Methods: Pts with histologic/cytologic evidence of BMinv from Jan2000 to Feb2012 and with any associated cytopenia were retrospectively identified from Pathology Department files.

Results: Twenty-nine pts were identified. Ductal histology: 62%, lobular 24%; Luminal (Lum = HR+/HER2−):76%; HER2+:7%, Triple negative (TN):17%. Stage: II 28%, III 34.5%, IV 24%; median (M) disease free interval: 39.6 months (m) (1.3–113.4). Time BC relapse to BMinv (M): 11.5 m (0–127). At time of BMinv onset: M age 54.7 years (34.3–77.6); M systemic Tx for metastatic disease 2 (0–7). BMinv was present at time of metastatic relapse in 11 pts, including 3 without overt bone metastasis (BM1). Other involved sites at BMinv onset: bone 90% (55% prior to BMinv), nodes 28%, liver 24% and pleuropulmonar 21%. Anemia was the most prominent hematologic sign (97%) followed by thrombocytopenia (Th) (76%) and neutropenia (35%). Tx efficacy in terms of blood count improvement (BCI) and tumor response (TR) outside BM are summarized in table 1. Most pts received non-mielotoxic regimens (endocrine therapy, weekly chemotherapy or capecitabine). ZA was administered in 22 pts (with or without overt BM1). Overall survival (OS)(M) for the whole group was 5.6m (0.3–72.9); M OS in Lum, and TN groups were 9.3 (0.4–72.9) & 0.4m (0.3–20.9+), respectively, while in the 2 HER2+ pts OS was 5.6 & 44.9+ m (p = 0.023). BC subtype, ECOG (0–1 vs 2–3), ZA use after BMinv onset and Th grade (0–1 vs ≥2) were related with OS in the univariate analysis for the whole population. ZA use after BMinv onset, Th grade and presence of BMinv at time of metastatic relapse were also significantly associated with OS in the Lum subgroup. In multivariate analysis, Th remained as an independent factor for OS both in the whole group and Lum subset. ZA use after BMinv onset showed a strong prognostic trend in the Lum group (p = 0.07).

Conclusions: BMinv has to be considered in BC pts with BM1 and otherwise unexplained cytopenia. Lum subtype correlates with 9 m M OS, while prognosis in TN subset appears to be particularly dismal. Severe th (&lt;75000 platelets) independently predicts poor OS both in the whole population and in the Lum subtype. In this latter group, a strong trend to better outcome was seen by using ZA after BMinv diagnosis. Futher studies exploring the role of ZA use in pts with BC and symptomatic BMinv are warranted.